Abstract:
BACKGROUND:The World Health Organization (WHO) released revised guidelines in 2015 recommending that all people living with HIV, regardless of CD4 count, initiate antiretroviral therapy (ART) upon diagnosis. However, few studies have projected the global resources needed for rapid scale-up of ART. Under the Health Policy Project, we conducted modeling analyses for 97 countries to estimate eligibility for and numbers on ART from 2015 to 2020, along with the facility-level financial resources required. We compared the estimated financial requirements to estimated funding available. METHODS AND FINDINGS:Current coverage levels and future need for treatment were based on country-specific epidemiological and demographic data. Simulated annual numbers of individuals on treatment were derived from three scenarios: (1) continuation of countries' current policies of eligibility for ART, (2) universal adoption of aspects of the WHO 2013 eligibility guidelines, and (3) expanded eligibility as per the WHO 2015 guidelines and meeting the Joint United Nations Programme on HIV/AIDS "90-90-90" ART targets. We modeled uncertainty in the annual resource requirements for antiretroviral drugs, laboratory tests, and facility-level personnel and overhead. We estimate that 25.7 (95% CI 25.5, 26.0) million adults and 1.57 (95% CI 1.55, 1.60) million children could receive ART by 2020 if countries maintain current eligibility plans and increase coverage based on historical rates, which may be ambitious. If countries uniformly adopt aspects of the WHO 2013 guidelines, 26.5 (95% CI 26.0 27.0) million adults and 1.53 (95% CI 1.52, 1.55) million children could be on ART by 2020. Under the 90-90-90 scenario, 30.4 (95% CI 30.1, 30.7) million adults and 1.68 (95% CI 1.63, 1.73) million children could receive treatment by 2020. The facility-level financial resources needed for scaling up ART in these countries from 2015 to 2020 are estimated to be US$45.8 (95% CI 45.4, 46.2) billion under the current scenario, US$48.7 (95% CI 47.8, 49.6) billion under the WHO 2013 scenario, and US$52.5 (95% CI 51.4, 53.6) billion under the 90-90-90 scenario. After projecting recent external and domestic funding trends, the estimated 6-y financing gap ranges from US$19.8 billion to US$25.0 billion, depending on the costing scenario and the U.S. President's Emergency Plan for AIDS Relief contribution level, with the gap for ART commodities alone ranging from US$14.0 to US$16.8 billion. The study is limited by excluding above-facility and other costs essential to ART service delivery and by the availability and quality of country- and region-specific data. CONCLUSIONS:The projected number of people receiving ART across three scenarios suggests that countries are unlikely to meet the 90-90-90 treatment target (81% of people living with HIV on ART by 2020) unless they adopt a test-and-offer approach and increase ART coverage. Our results suggest that future resource needs for ART scale-up are smaller than stated elsewhere but still significantly threaten the sustainability of the global HIV response without additional resource mobilization from domestic or innovative financing sources or efficiency gains. As the world moves towards adopting the WHO 2015 guidelines, advances in technology, including the introduction of lower-cost, highly effective antiretroviral regimens, whose value are assessed here, may prove to be "game changers" that allow more people to be on ART with the resources available.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Dutta A,Barker C,Kallarakal Adoi
10.1371/journal.pmed.1001907subject
Has Abstractpub_date
2015-11-24 00:00:00pages
e1001907; discussion e1001907issue
11eissn
1549-1277issn
1549-1676pii
PMEDICINE-D-15-00516journal_volume
12pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract::Diarrhea morbidity and mortality remain important child health problems in low- and middle-income countries. The treatment of diarrhea and accurate measurement of treatment coverage are critical if child mortality is going to continue to decline. In this review, we examine diarrhea treatment coverage indicators collec...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.1001385
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVI...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003379
更新日期:2020-09-22 00:00:00
abstract:BACKGROUND:Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on long-term mortality trends in the US ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050066
更新日期:2008-04-22 00:00:00
abstract:BACKGROUND:The "fitness" of an infectious pathogen is defined as the ability of the pathogen to survive, reproduce, be transmitted, and cause disease. The fitness of multidrug-resistant tuberculosis (MDRTB) relative to drug-susceptible tuberculosis is cited as one of the most important determinants of MDRTB spread and ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001843
更新日期:2015-06-23 00:00:00
abstract:BACKGROUND:With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. ME...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析,多中心研究
doi:10.1371/journal.pmed.1002853
更新日期:2019-07-23 00:00:00
abstract:BACKGROUND:Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal disorder characterized by fibroproliferation and excessive accumulation of extracellular matrix in the lung. METHODS AND FINDINGS:Using oligonucleotide arrays, we identified osteopontin as one of the genes that significantly distinguishes IPF f...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020251
更新日期:2005-09-01 00:00:00
abstract::In a Perspective, David Peiris and Dorairaj Prabhakaran discuss implications and challenges of cardiovascular disease risk assessments in the population of India. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002582
更新日期:2018-06-19 00:00:00
abstract:BACKGROUND:The response to the next influenza pandemic will likely include extensive use of antiviral drugs (mainly oseltamivir), combined with other transmission-reducing measures. Animal and in vitro studies suggest that some strains of influenza may become resistant to oseltamivir while maintaining infectiousness (f...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040015
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objec...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001599
更新日期:2014-02-04 00:00:00
abstract:BACKGROUND:Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretrovi...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1001015
更新日期:2011-03-01 00:00:00
abstract::The PLOS Medicine editors discuss the new extension to the PRISMA reporting guidelines, PRISMA for Equity (PRISMA-E), and why it is relevant to the journal and to health research more generally. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1001334
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:The proteases (secretases) that cleave amyloid-beta (Abeta) peptide from the amyloid precursor protein (APP) have been the focus of considerable investigation in the development of treatments for Alzheimer disease. The prediction has been that reducing Abeta production in the brain, even after the onset of c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020355
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence about whether it is more beneficial to provide both interventions in combination. A cluster randomised controlled trial was conducted to investigate wheth...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001630
更新日期:2014-04-15 00:00:00
abstract:BACKGROUND:It has been suggested throughout the past fifty years that serum uric acid concentrations can help predict the future risk of coronary heart disease (CHD), but the epidemiological evidence is uncertain. METHODS AND FINDINGS:We report a "nested" case-control comparison within a prospective study in Reykjavik...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.0020076
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness o...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001876
更新日期:2015-09-15 00:00:00
abstract:BACKGROUND:The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research aimed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during s...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002863
更新日期:2019-07-30 00:00:00
abstract::Mirjam Kretzschmar and colleagues describe the BCoDE project, which uses a pathogen-based incidence approach to better estimate the infectious disease burden in Europe. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001205
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies link...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001943
更新日期:2016-01-19 00:00:00
abstract::In an essay, Paul Bloem and Ikechukwu Ogbuanu discuss the public health implications of HPV vaccination. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002325
更新日期:2017-06-27 00:00:00
abstract:BACKGROUND:Bilharzia is one of the major parasitic infections affecting the public health and socioeconomic circumstances in (sub) tropical areas. Its causative agents are schistosomes. Since these worms remain in their host for decades, they have developed mechanisms to evade or resist the immune system. Like several ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030253
更新日期:2006-08-01 00:00:00
abstract::In an Editorial accompanying PLOS Medicine's Special Issue on Diabetes Prevention, Guest Editors Nicholas Wareham and William Herman discuss some of the challenges for researchers and policy makers in developing effective and equitable solutions to the worldwide problem of type 2 diabetes. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002097
更新日期:2016-07-26 00:00:00
abstract:BACKGROUND:Socioeconomic disparities in infant mortality have persisted for decades in high-income countries and may have become stronger in some populations. Therefore, new understandings of the mechanisms that underlie socioeconomic differences in infant deaths are essential for creating and implementing health initi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002831
更新日期:2019-06-14 00:00:00
abstract:BACKGROUND TO THE DEBATE:The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040185
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001925
更新日期:2015-12-22 00:00:00
abstract:BACKGROUND:The US Food and Drug Administration Amendments Act requires results from clinical trials of Food and Drug Administration-approved drugs to be posted at ClinicalTrials.gov within 1 y after trial completion. We compared the timing and completeness of results of drug trials posted at ClinicalTrials.gov and publ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001566
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. METHODS AND FINDINGS:The methodology developed by the World Health O...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040082
更新日期:2007-03-27 00:00:00
abstract:BACKGROUND:Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, an...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050032
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of t...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000039
更新日期:2009-03-03 00:00:00
abstract:BACKGROUND:The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO) expert panel on SARS treatment requested a systematic review and comprehensive s...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.0030343
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. METHODS AND FINDINGS:We evaluated the interacti...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1002373
更新日期:2017-08-08 00:00:00